CPT Code 58661 Laparoscopy, Surgical; with Lysis of Adhesions (Salpingolysis, Ovariolysis)

Pelvic surgeries like laparoscopic salpingo-oophorectomy require not only surgical precision but also billing accuracy. CPT 58661 is used when a physician performs the laparoscopic removal of one or both adnexal structures, meaning the fallopian tube, ovary, or both, typically to treat conditions such as cysts, ectopic pregnancy, or chronic pelvic pain.

Because this is a major gynecologic laparoscopy, the correct use of CPT 58661 is crucial for proper reimbursement and compliance with payer rules.

Understanding the Procedure

“Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy).”

This code covers laparoscopic removal of adnexal organs -either one or both ovaries, one or both fallopian tubes, or both together. The laparoscopic approach allows surgeons to treat conditions less invasively, resulting in faster recovery compared to open procedures.

The code can represent procedures such as:

• Laparoscopic salpingectomy – removal of one/both fallopian tubes.
• Laparoscopic oophorectomy – removal of one/both ovaries.
• Laparoscopic salpingo-oophorectomy – removal of both the ovary and tube.

When to Use CPT 58661

Use CPT 58661 when the physician performs therapeutic laparoscopic removal of adnexal structures for a clear medical reason.

Typical Indications Include:

• Ovarian cysts or benign ovarian neoplasms.
• Chronic pelvic pain from diseased adnexa.
• Tubo-ovarian abscess unresponsive to antibiotics.
• Ectopic pregnancy requiring removal of the tube or adnexa.
• Risk-reducing bilateral oophorectomy in high-risk patients (e.g., BRCA mutation).

Do not report CPT 58661 when:

• The adnexal removal is incidental to another primary procedure (e.g., laparoscopic hysterectomy).
• The procedure is performed via an open approach (use 58940 or 58943).
• The surgeon only drains a cyst without removing the ovary (use 49322 or 58662 if applicable).

Billing Insight: Key Documentation Focus

Because adnexal surgeries often overlap with other laparoscopic procedures, clarity in the operative note is everything.

Document clearly:

• Which structure(s) were removed -ovary, tube, or both.
• Whether unilateral or bilateral.
• The indication (pain, mass, torsion, infection, prophylaxis).
• Extent of dissection and any complications.
• Surgical approach (laparoscopic).

Billing Tip: If bilateral removal is performed, CPT 58661 still reports the entire procedure -do not bill twice. Some payers may allow a modifier 50 for bilateral procedures; verify payer policy before submission.

Reimbursement Overview

While actual rates vary by payer and region, CPT 58661 is reimbursed as a major laparoscopic surgery.

Average Reimbursement Ranges (Medicare data):

• Physician Fee (Facility): ~$950–$1,100
• ASC Facility Fee: ~$1,600–$1,900
• Global Period: 90 days

Common ICD-10 Codes Supporting CPT 58661:

• N83.201–N83.209 – Unspecified ovarian cysts.
• N70.11–N70.13 – Chronic salpingitis and oophoritis.
• N83.8 – Other noninflammatory ovarian disorders.
• O00.101–O00.109 – Tubal pregnancy.

Modifiers to Use

Proper modifier use helps avoid denials:

• Modifier 50 – Bilateral procedure (if payer allows).
• Modifier 51 – Multiple procedures (if performed with other unrelated laparoscopic codes).
• Modifier 59 – Distinct procedural service (if done separately from another laparoscopic intervention).
• Modifier 52 – Reduced service (if incomplete due to intraoperative findings).
• Modifiers 54/55 – Split surgical and postoperative care when applicable.

Compliance Note: Do not use modifier 59 to unbundle routine or incidental adnexal work during another laparoscopic procedure unless documentation supports a distinct operative intent.

Example Scenarios

Scenario 1 – Unilateral Salpingo-Oophorectomy for Torsion

A 28-year-old woman presents with acute pelvic pain. Laparoscopy reveals a right adnexal torsion involving both the ovary and tube. The surgeon removes the right ovary and fallopian tube.

→ Report CPT 58661.

Scenario 2 – Bilateral Oophorectomy for Ovarian Cysts

A patient with persistent bilateral cystic ovaries undergoes laparoscopic removal of both ovaries to relieve pain and prevent recurrence.

→ Report CPT 58661 with modifier 50 if the payer recognizes bilateral coding.

Scenario 3 – Combined Hysterectomy and Oophorectomy

A patient undergoes a laparoscopic total hysterectomy with bilateral salpingo-oophorectomy.

→ Do not report CPT 58661 separately -the adnexal removal is included in the hysterectomy code (e.g., 58571).

Documentation Reminder: A Clear indication of the surgical intent -therapeutic vs. prophylactic- helps validate medical necessity and ensures payer acceptance.

Common Coding Challenges and How to Avoid Them

Coding laparoscopic adnexal procedures often looks straightforward, but in reality, CPT 58661 carries several subtle challenges that can affect payment accuracy. Understanding where most errors occur helps practices strengthen their documentation and prevent denials before they happen.

Unbundling During Combined Procedures

One of the most frequent mistakes occurs when coders bill CPT 58661 separately during a laparoscopic hysterectomy or other major pelvic surgery. In most cases, adnexal removal (tube and/or ovary) is already included in the hysterectomy code. Submitting both can lead to denials or payer recoupments.

Tip: Always review the primary surgical CPT and check if adnexal work is bundled per NCCI edits before submitting a separate charge.

Bilateral Coding Confusion

Because CPT 58661 already includes unilateral or bilateral removal, reporting the code twice (once per side) is incorrect. However, some payers request a modifier 50 to indicate bilateral work for tracking or payment purposes.

Tip: Verify each payer’s bilateral surgery policy. Document “bilateral removal of adnexa” clearly in the operative note so your billing team can apply the correct modifier approach.

Incomplete or Ambiguous Documentation

When the operative note fails to specify which adnexal structure was removed or the surgical intent (therapeutic vs. prophylactic), payers may reject the claim or request additional records.

Tip: Ensure your operative reports clearly identify:

• Whether one or both sides were treated.
• The clinical indication (e.g., cyst, torsion, prophylactic removal).
• The surgical extent and approach (laparoscopic).

Misuse of Modifier 59

Modifier 59 is sometimes used incorrectly to “unbundle” 58661 from another laparoscopic procedure, such as adhesiolysis or cyst excision, even when both are part of the same operative field. This can trigger audits or compliance issues.

Tip: Use Modifier 59 only when the adnexal removal is truly distinct, involving separate anatomic sites or operative intent. Documentation must reflect this distinction.

Prior Authorization and Medical Necessity Issues

For prophylactic or risk-reducing oophorectomy cases, payers often require preauthorization and genetic risk documentation. Missing or incomplete justification can delay payments or result in claim denials.

Tip: Submit all supporting evidence, such as family history, BRCA mutation results, or clinical notes, with your claim to prove medical necessity and secure prompt approval.

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